COVERAGE
Description:
The COVERAGE table contains high-level information on both managed care and indemnity coverage records in your system.

Primary Key
Column Name Ordinal Position
COVERAGE_ID 1

Column Information
Name Type Discontinued?
1 COVERAGE_ID NUMERIC No
The unique ID assigned to the coverage record. This ID may be encrypted if you have elected to use enterprise reporting’s encryption utility.
2 COVERAGE_TYPE_C_NAME VARCHAR No
The category value that indicates whether a coverage is managed care or indemnity; 1 – Indemnity, 2 – Managed Care.
May contain organization-specific values: No
Category Entries:
Indemnity
Managed Care
3 PAYOR_ID_PAYOR_NAME VARCHAR No
The name of the payor.
4 PLAN_ID_BENEFIT_PLAN_NAME VARCHAR No
The name of the benefit plan record.
5 PLAN_GRP_ID VARCHAR No
The ID of the employer group that determines the benefits in a managed care coverage. This item is NULL for indemnity coverages.
6 PLAN_GRP_ID_PLAN_GRP_NAME VARCHAR No
The name of the employer group record
7 COBRA_STATUS_YN VARCHAR No
This yes/no flag is set to “Y” if the coverage has been extended beyond termination of the subscriber’s employment according to a COBRA arrangement. If the coverage has not been extended under such an arrangement, this value is “N” or null.
May contain organization-specific values: No
Category Entries:
Yes
No
8 COBRA_DATE DATETIME No
The termination date for any COBRA arrangement.
9 LATE_ENROLL_YN VARCHAR No
Y if the subscriber applied for coverage outside of the open enrollment period. N or NULL if not specified as a late enrollment coverage.
May contain organization-specific values: No
Category Entries:
Yes
No
10 STUDENT_REVIEW_DT DATETIME No
The date on which you should review the status of any members on this coverage who are students.
11 EPIC_CVG_ID NUMERIC No
The unique ID of the coverage record. This column may be hidden if you have elected to use enterprise reporting’s security utility.
12 PB_ACCT_ID VARCHAR No
The unique ID of premium billing account associated with the coverage.
13 CVG_EFF_DT DATETIME No
The effective date of the coverage.
14 CVG_TERM_DT DATETIME No
The termination date of the coverage.
15 CASEHEAD_NUMBER VARCHAR No
The Medicaid ID number on the case head.
16 CASEHEAD_NAME VARCHAR No
The Medicaid name on the case head.
17 TNSFRD_COVERAGE_ID NUMERIC No
The ID of the coverage from which this coverage is transferred from.
18 CVG_REG_STATUS_C_NAME VARCHAR No
The verification status of the coverage, such as verified, changed, elapsed, etc.
May contain organization-specific values: Yes
19 VERIFY_USER_ID VARCHAR No
The ID of the user who performed the verification.
20 VERIFY_USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
21 GROUP_NAME VARCHAR No
The name of the coverage group.
22 CVG_ADDR1 VARCHAR No
The first line of the address of the coverage (administrative offices).
23 CVG_ADDR2 VARCHAR No
The second line of the address of the coverage (administrative offices).
24 CVG_CITY VARCHAR No
The city of the mailing address of the coverage (administrative offices).
25 CVG_ZIP VARCHAR No
The zip code of the mailing address of the coverage (administrative offices).
26 CVG_PHONE1 VARCHAR No
The primary phone number of the coverage (administrative offices).
27 GROUP_NUM VARCHAR No
The identification number assigned to this subscriber's employer/plan group by the payor. This number will appear in box 11 of the HCFA claim form.
28 CLAIM_MAIL_CODE_C_NAME VARCHAR No
The category value associated with where to send the claim on a coverage (i.e. send claim to payor, send claim to account, etc.)
May contain organization-specific values: No
Category Entries:
Payer
Account
Payer Plan
Coverage Address
29 WC_EMPLOYER_ID VARCHAR No
Workers' compensation employer at the time of injury.
30 WC_EMPLOYER_ID_EMPLOYER_NAME VARCHAR No
The name of the employer.
31 WC_DATE_OF_INJURY DATETIME No
Workers Comp date of injury. This is the date the injury occurred on the job. This field is populated as the user sets up the WC account.
32 IS_SIG_ON_FILE_YN VARCHAR No
Appears in Box 12 of HCFA claims. This is a Yes/No field that denotes whether authorization has been obtained to send bill or other documentation to payor for services relating to the claim.
May contain organization-specific values: No
Category Entries:
Yes
No
33 ENROLL_REASON_C_NAME VARCHAR No
This category value stores the enrollment reason of the coverage.
May contain organization-specific values: Yes
34 CVG_TERM_REASON_C_NAME VARCHAR No
This category value stores the termination reason of the coverage.
May contain organization-specific values: Yes
35 PAT_REC_OF_SUBS_ID VARCHAR No
If the subscriber is the same person as a patient, this item contains the patient ID.
36 ECD_TABLE_DEF_COPAY NUMERIC No
Numeric default copay value.
37 COINSURANCE_OVR NUMERIC No
Numeric Value for the coverage level coinsurance override.
38 MEDC_COVERED_LEFT NUMERIC No
This is the number of Medicare Covered Days Remaining
39 MEDC_COINS_LEFT NUMERIC No
This is the number of Medicare Coinsurance Days Remaining
40 MEDC_RESERVE_LEFT NUMERIC No
This is the number of Medicare Reserved Days Remaining
41 CCS_PAT_ID VARCHAR No
The patient's Comprehensive Community Services (CCS) ID.
42 CCS_DX VARCHAR No
Stores the diagnosis that makes the patient eligible for Comprehensive Community Services (CCS) coverage.
43 CCS_CC_NAME VARCHAR No
Stores the name of the Comprehensive Community Services (CCS) Case Coordinator.
44 CCS_COOR_PHONE VARCHAR No
Stores the phone number for the Comprehensive Community Services (CCS) Case Coordinator.
45 CCS_COUNTY_PHONE VARCHAR No
Stores the phone number for the Comprehensive Community Services (CCS) County Office.
46 CVG_COUNTY_C_NAME VARCHAR No
The county of the mailing address of the coverage (administrative offices).
May contain organization-specific values: Yes
47 CVG_COUNTRY_C_NAME VARCHAR No
The country of the mailing address of the coverage (administrative offices).
May contain organization-specific values: Yes
48 CVG_HOUSE_NUM VARCHAR No
The house number of the mailing address of the coverage (administrative offices).
49 CVG_DISTRICT_C_NAME VARCHAR No
The district of the mailing address of the coverage (administrative offices).
May contain organization-specific values: Yes
50 EFF_HOSP_CVG_DT DATETIME No
The effective date of Medicare Part A.
51 EFF_PROV_CVG_DT DATETIME No
The effective date of Medicare Part B.
52 MEDICARE_CVG_TYPE_C_NAME VARCHAR No
The category number for the type of Medicare coverage the patient has.
May contain organization-specific values: No
Category Entries:
Part A
Part B
Parts A & B
53 Q4CO_BUCKETS_EXC_YN VARCHAR No
Flag to indicate if bucket limits exceeded during carryover
May contain organization-specific values: No
Category Entries:
Yes
No
54 MED_SEC_TYPE_C_NAME VARCHAR No
Medicare Secondary Insurance Type Code.
May contain organization-specific values: No
Category Entries:
Working Aged Beneficiary or Spouse with EGHP
ESRD Beneficiary in the Mandated Coordination Period with an EGHP
No-fault Insurance Including Auto is Primary
Worker's Compensation
Public Health Service (PHS) or Other Federal Agency
Black Lung
Veteran's Administration
Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
Other Liability Insurance is Primary
55 CHDP_COUNTY_C_NAME VARCHAR No
The Child Health and Disability Prevention County Code.
The category values for this column were already listed for column: CVG_COUNTY_C_NAME
56 CHDP_AID_CODE VARCHAR No
The Child Health and Disability Prevention Aid Code.
57 CVG_CARD_ISSUE_DT DATETIME No
Stores the card issue date.
58 CVG_DEDUCTIBLE_YN VARCHAR No
This item will serve as a flag to let the end user know if the response has any deductible information
May contain organization-specific values: No
Category Entries:
No
Yes
59 FIRST_SPEC_AID_CODE VARCHAR No
First special aid code for the Treatment Authorization Request (TAR) for Medi-Cal.
60 SEC_SPEC_AID_CODE VARCHAR No
Second special aid code for the Treatment Authorization Request (TAR) for Medi-Cal.
61 THRD_SPEC_AID_CODE VARCHAR No
Third special aid code for the Treatment Authorization Request (TAR) for Medi-Cal.
62 EVC_NUM VARCHAR No
Eligibility Verification Confirmation (EVC) that is used on the Treatment Authorization Request (TAR) for Medi-Cal.
63 COUNTY_CODE_C_NAME VARCHAR No
This item will store the county code that is returned from the 271 message.
May contain organization-specific values: Yes
No Entries Defined
64 EXT_ROUTING_NUM_C_NAME VARCHAR No
The external routing number for the coverage
May contain organization-specific values: Yes
No Entries Defined
65 SUBSCR_OR_SELF_MEM_PAT_ID VARCHAR No
This item contains the subscriber patient Id of a coverage and will be used to associate patients with linked premium billing accounts for EHI.